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Sasikumar N, Kumar RK, Balaji S. Diagnosis and management of junctional ectopic tachycardia in children. Ann Pediatr Cardiol 2021; 14:372-381. [PMID: 34667411 PMCID: PMC8457265 DOI: 10.4103/apc.apc_35_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/16/2021] [Accepted: 04/27/2021] [Indexed: 11/13/2022] Open
Abstract
Junctional ectopic tachycardia (JET) is more common in its postoperative form. A thorough understanding of its etiology, pathophysiology, and management strategies is essential. Classically, postoperative JET is considered to arise from surgical trauma. Genetic susceptibility and an intrinsic morphologic/functional defect in the conduction system inherent in congenital heart diseases likely play a significant role. The devastating effects on postoperative hemodynamics warrant prompt attention. A multipronged management approach with general measures, pharmacotherapy, and pacing has decreased morbidity and mortality. Amiodarone and procainamide remain the preferred drugs, while ivabradine appears promising. Carefully planned randomized trials can go a long way in developing a systematic management protocol for postoperative JET.
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Affiliation(s)
- Navaneetha Sasikumar
- Department of Pediatric Cardiology and Adult Congenital Heart Disease, Meditrina Hospital, Ayathil, Kollam, Kerala, India
| | - Raman Krishna Kumar
- Department of Pediatric Cardiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Seshadri Balaji
- Department of Pediatrics (Cardiology), Oregon Health and Science University, Portland, Oregon, USA
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Aoki H, Suzuki T, Matsui H, Yasukochi S, Saiki H, Senzaki H, Nakamura Y. Efficacy of a pure Ikr blockade with nifekalant in refractory neonatal congenital junctional ectopic tachycardia and careful attention to damaging the atrioventricular conduction during the radiofrequency catheter ablation in infancy. HeartRhythm Case Rep 2017. [PMID: 28649501 PMCID: PMC5469282 DOI: 10.1016/j.hrcr.2017.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Hisaaki Aoki
- Department of Pediatrics, Faculty of Medicine, Kinki University, Osaka, Japan
- Address reprint requests and correspondence: Dr Hisaaki Aoki, Department of Pediatric Cardiology, Osaka Medical Center and Research Institute for Child and Maternal Health, 840 Murodocho Izumi, Osaka 594–1101, Japan.Department of Pediatric CardiologyOsaka Medical Center and Research Institute for Child and Maternal Health840 Murodocho IzumiOsaka594–1101Japan
| | - Tsugutoshi Suzuki
- Department of Pediatric Electrophysiology, Osaka City General Hospital, Osaka, Japan
| | - Hikoro Matsui
- Division of Pediatric Cardiology, Nagano Children's Hospital, Nagano, Japan
| | - Satoshi Yasukochi
- Division of Pediatric Cardiology, Nagano Children's Hospital, Nagano, Japan
| | - Hirofumi Saiki
- Department of Pediatric Cardiology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Hideaki Senzaki
- Department of Pediatric Cardiology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Yoshihide Nakamura
- Department of Pediatrics, Faculty of Medicine, Kinki University, Osaka, Japan
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Collins KK, Van Hare GF, Kertesz NJ, Law IH, Bar-Cohen Y, Dubin AM, Etheridge SP, Berul CI, Avari JN, Tuzcu V, Sreeram N, Schaffer MS, Fournier A, Sanatani S, Snyder CS, Smith RT, Arabia L, Hamilton R, Chun T, Liberman L, Kakavand B, Paul T, Tanel RE. Pediatric Nonpost-Operative Junctional Ectopic Tachycardia. J Am Coll Cardiol 2009; 53:690-7. [DOI: 10.1016/j.jacc.2008.11.019] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2008] [Revised: 11/12/2008] [Accepted: 11/16/2008] [Indexed: 10/21/2022]
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Erickson S. Guidelines for the management of junctional ectopic tachycardia following cardiac surgery in children. ACTA ACUST UNITED AC 2006. [DOI: 10.1016/j.cupe.2006.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Law IH, Von Bergen NH, Gingerich JC, Saarel EV, Fischbach PS, Dick M. Transcatheter cryothermal ablation of junctional ectopic tachycardia in the normal heart. Heart Rhythm 2006; 3:903-7. [PMID: 16876738 DOI: 10.1016/j.hrthm.2006.04.026] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2006] [Accepted: 04/26/2006] [Indexed: 12/01/2022]
Abstract
BACKGROUND Junctional ectopic tachycardia in the normal heart is rare and often is resistant to pharmacologic management. Transcatheter ablation using radiofrequency energy places the AV node at risk. OBJECTIVES The purpose of this study was to report our experience with transcatheter cryothermal ablation using three-dimensional mapping in six patients with junctional ectopic tachycardia. METHODS A review of clinical and electrophysiologic data was performed on all patients with structurally normal hearts who underwent cryothermal ablation for treatment of junctional ectopic tachycardia at two institutions. RESULTS Six patients (age 7.7-36.5 years) underwent attempted transcatheter cryothermal ablation using three-dimensional mapping. Only one patient had achieved arrhythmia suppression on medical management. Cryothermal mapping (-30 degrees C) localized the junctional focus while normal conduction was monitored. The junctional focus was high in the triangle of Koch in four patients and was low in one patient. The sixth patient had only one run of junctional ectopic tachycardia during the procedure and therefore received an empiric cryoablation (-70 degrees C) lesion. Subsequent cryoablation lesions were delivered at and around the junctional focus. In one patient, cryomapping eliminated the junctional focus but resulted in transient complete AV block; therefore, cryoablation was not performed. All patients who received the cryoablation lesions had elimination of their junctional ectopic tachycardia at 6-week follow-up. The patient who did not receive a cryoablation lesion remained in a slower junctional rhythm at follow-up. CONCLUSION Cryoablation of junctional ectopic tachycardia is safe and effective. Nonetheless, proximity to the His-Purkinje system may preclude success. Empiric cryoablation can be effective; cryotherapy may not yield immediate success, but a delayed salutary effect can follow.
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Affiliation(s)
- Ian H Law
- Children's Hospital of Iowa, University of Iowa Hospitals and Clinics, Iowa City, 55242-1083, USA.
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Emmel M, Sreeram N, Brockmeier K. Catheter ablation of junctional ectopic tachycardia in children, with preservation of atrioventricular conduction. ACTA ACUST UNITED AC 2005; 94:280-6. [PMID: 15803265 DOI: 10.1007/s00392-005-0215-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2004] [Accepted: 12/08/2004] [Indexed: 10/25/2022]
Abstract
BACKGROUND Idiopathic junctional ectopic tachycardia is a rare arrhythmia in children. Several studies have demonstrated that drug therapy is often ineffective and sometimes the only achieved effect is rate control. Early presentation and frequent recurrence are associated with adverse outcome. PATIENTS AND METHODS Three consecutive children, aged 9, 7 and 12 years respectively, underwent radiofrequency catheter ablation for junctional ectopic tachycardia, after having failed antiarrhythmic drug therapy. The entire His bundle was plotted out and marked, using the Localisa navigation system. The arrhythmia was readily and repeatedly inducible using intravenous isoprenaline infusion and the site of earliest retrograde conduction during tachycardia could be assessed. Ablations were performed in sinus rhythm, empirically targeting the site of earliest retrograde conduction during tachycardia. RESULTS This approach was successful in abolishing tachyarrhythmia in the first two patients, in whom the successful ablation site was located superoparaseptally. In the third patient, junctional ectopic tachycardia was inducible, despite abolishing retrograde atrial activation, in a septal location on the tricuspid valve annulus. Further ablations in the superoparaseptal region, closer to the His bundle, were successful in rendering tachyarrhythmia noninducible. Over a median follow-up of 10 months, none of the patients has had recurrence of arrhythmia, despite discontinuing all antiarrhythmic medications. CONCLUSIONS Radio frequency catheter ablation of junctional ectopic tachycardia is feasible with preservation of atrioventricular conduction.
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Affiliation(s)
- M Emmel
- Department of Paediatric Cardiology, University Hospital of Cologne, Joseph-Stelzmann-Strasse 9, 50924 Cologne, Germany
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Bae EJ, Kang SJ, Noh CI, Choi JY, Yun YS. A Case of Congenital Junctional Ectopic Tachycardia: Prenatal Diagnosis and Successful Radiofrequency Catheter Ablation in Infancy. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2005; 28:254-7. [PMID: 15733191 DOI: 10.1111/j.1540-8159.2005.40011.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
It is difficult to make a definitive diagnosis of congenital junctional ectopic tachycardia (JET) in utero. We report a case in which congenial JET was suspected by fetal M-mode echocardiography. Fetal M-mode tracing of the atria and ventricle clearly showed a gradual acceleration of ventricular activity at the beginning of tachycardia, the warming-up sign of ectopic tachycardia, which was followed by simultaneous contractions of atrium and ventricle. This report also describes successful emergent radiofrequency catheter ablation of congenital JET in infancy with preservation of normal AV nodal conduction for this patient.
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Affiliation(s)
- Eun-Jung Bae
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea.
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Simmers TA, Sreeram N, Wittkampf FHM, Derksen R. Radiofrequency catheter ablation of junctional ectopic tachycardia with preservation of atrioventricular conduction. Pacing Clin Electrophysiol 2003; 26:1284-8. [PMID: 12765459 DOI: 10.1046/j.1460-9592.2003.t01-1-00181.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Junctional ectopic tachycardia is a relatively rare disorder, frequently refractory to drug therapy, and with a poor prognosis in childhood. This report describes a successful radiofrequency catheter ablation of the focus of this arrhythmia in a 9-year-old girl with preservation of normal atrioventricular conduction, using precise catheter navigation with the LocaLisa system and carefully titrated RF delivery.
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Affiliation(s)
- Timothy A Simmers
- Department of Clinical Electrophysiology, University Medical Center, Utrecht, The Netherlands.
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Fukuhara H, Nakamura Y, Ohnishi T. Atrial pacing during radiofrequency ablation of junctional ectopic tachycardia--a useful technique for avoiding atrioventricular bloc. JAPANESE CIRCULATION JOURNAL 2001; 65:242-4. [PMID: 11266203 DOI: 10.1253/jcj.65.242] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Radiofrequency catheter ablation (RFCA) was performed on a 5-year-old boy with congenital junctional ectopic tachycardia (JET) that was refractory to medical management. Because of the lack of retrograde atrial depolarization during tachycardia, radiofrequency energy was delivered during atrial overdrive pacing to confirm the presence of preserved atrioventricular (AV) conduction. Although the procedure was complicated by complete right bundle branch block after ablation of the para-Hissian region, the patient regained sinus rhythm accompanied by normal AV conduction. Rapid atrial pacing during RFCA of JET may be safely used to avoid AV block.
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Affiliation(s)
- H Fukuhara
- Department of Pediatrics, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan.
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Abstract
Supraventricular tachycardia (SVT) is the most common sustained arrhythmia to present in the neonatal and infancy age group. Predisposing factors (congenital heart disease, drug administration, illness and fever) occur only in 15% of infants. The presentation of SVT in the neonate is frequently subtle, and may include pallor, cyanosis, restlessness, irritability, feeding difficulty, tachypnea, diaphoresis and grunting. Congestive heart failure is more common in infants under 4 months of age (35% incidence). Age-related differences in the distribution of SVT mechanisms occur in different age groups. In infants under 1 year of age, the mechanisms underlying SVT are atrial tachycardia (15%), AV nodal re-entry tachycardia (5%), and AV reciprocating tachycardia (80%). Options for acute management include: use of the diving reflex, intravenous adenosine, transesophageal pacing, and cardioversion. Intravenous administration of verapamil should be avoided. Data regarding freedom from recurrence of untreated SVT in the first year of life are limited, and may be in the range of 25-60%. Chronic therapy with digoxin, beta-blockers, flecainide, sotalol and amiodarone has proved effective in controlling recurrent episodes of SVT. Radiofrequency ablation can be employed successfully in medically refractory cases, but should be avoided in this age group (increased complication rate).
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Affiliation(s)
- JP Moak
- Children's National Medical Center, Department of Cardiology, George Washington University School of Medicine, 111 Michigan Avenue, NW 20010, Washington, DC, USA
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Al-Sheikh T, Zipes DP. Guidelines for Competitive Athletes with Arrhythmias. DEVELOPMENTS IN CARDIOVASCULAR MEDICINE 2000. [DOI: 10.1007/978-94-017-0789-3_9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Fishberger SB, Rossi AF, Messina JJ, Saul JP. Successful radiofrequency catheter ablation of congenital junctional ectopic tachycardia with preservation of atrioventricular conduction in a 9-month-old infant. Pacing Clin Electrophysiol 1998; 21:2132-5. [PMID: 9826867 DOI: 10.1111/j.1540-8159.1998.tb01134.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
An infant with congenital junctional ectopic tachyardia required frequent hospitalizations due to tachycardia acceleration despite multiple antiarrhythmic medications. At 9 months of age, he underwent successful radiofrequency catheter ablation of the tachycardia with preservation of AV conduction.
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Affiliation(s)
- S B Fishberger
- Division of Pediatric Cardiology, Mount Sinai Medical Center, New York, New York 10029-6574, USA
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Abstract
PURPOSE To report the management of junctional ectopic tachycardia after cardiac surgery in an infant. Postoperatively, the patient suffered profound cardiac decompensation secondary to the accelerated rhythm and required extracorporeal membrane oxygenation (ECMO) for haemodynamic support. CLINICAL FEATURES A 14-day-old, 3.5 kg boy exhibited junctional ectopic tachycardia after cardiopulmonary bypass. Left atrial pressure was 25-28 mmHg. No impact on the tachycardia was seen after rapid overdrive atrial pacing or after 20 micrograms fentanyl i.v., 45 micrograms digitalis, 100 mg magnesium or procainamide (loading dose 15 mg, then 30 mg.kg-1.min-1). Active cooling decreased the nasopharyngeal temperature to 35.2 degrees C, when the heart rate decreased below 180 bpm with a left atrial pressure of 8-10 mmHg. Dopamine (2 micrograms.kg-1.min-1) and dobutamine (5 micrograms.kg-1.min-1) were added to improve the cardiac output. Sodium nitroprusside (0.25 to 1 microgram.kg-1.min) maintained the systolic pressure < 100 mmHg. On arrival in ICU, heart rate increased to 200 bpm. The patient received cardiac massage for severe hypotension 75 min after surgery. Emergency ECMO was instituted for circulatory support. Procainamide, digoxin, dopamine, dobutamine, sodium nitroprusside and hypothermia were continued. Sinus rhythm resumed on the first postoperative day, but procainamide and induced hypothermia at 34 degrees C were maintained for 36 hr after normalization of the rhythm to prevent recurrence of the tachycardia. Total duration of ECMO was three and a half days. Recovery was uneventful. CONCLUSION The use of ECMO, as a first line of defence, is suitable for the emergency support of patients with JET because of the ease of support of circulation and precise control of hypothermia.
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Affiliation(s)
- F J Azzam
- Department of Anesthesiology, Saint Louis University Medical Center, MO 63110, USA
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14
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Abstract
Narrow complex tachycardia with VA block is rare. The differential diagnosis usually consists of (1) junctional tachycardia (JT) with retrograde block; (2) AV nodal reentrant tachycardia (AVNRT) with proximal common pathway block; and finally (3) nodofascicular tachycardia using the His-Purkinje system for antegrade conduction and a nodofascicular pathway for retrograde conduction. Analysis of tachycardia onset and termination, the effect of bundle branch block on tachycardia cycle length, and the response to atrial and ventricular premature depolarization must be carefully done. Making the correct diagnosis is crucial as the success rate in eliminating the tachycardia will depend on tachycardia mechanism.
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Affiliation(s)
- M H Hamdan
- UT Southwestern and Dallas VAMC, Cardiology Department, Texas 75216, USA
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Hamdan M, Van Hare GF, Fisher W, Gonzalez R, Dorostkar P, Lee R, Lesh M, Saxon L, Kalman J, Scheinman M. Selective catheter ablation of the tachycardia focus in patients with nonreentrant junctional tachycardia. Am J Cardiol 1996; 78:1292-7. [PMID: 8960595 DOI: 10.1016/s0002-9149(96)00616-9] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We describe a technique for ablation of junctional tachycardia focus by means of examining the earliest atrial activation sequence during tachycardia. The procedure was successful in 7 of 9 patients, and 1 developed complete atrioventricular block.
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Affiliation(s)
- M Hamdan
- University of California, San Francisco 94143, USA
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Mehta AV, Subrahmanyam AB, Long JB, Kanter RJ. Experience with moricizine HCl in children with supraventricular tachycardia. Int J Cardiol 1996; 57:31-5. [PMID: 8960940 DOI: 10.1016/s0167-5273(96)02763-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Eight children, age between 4.5 and 19 years were treated with moricizine for supraventricular tachycardia during the last 3 years. The tachycardia was documented by surface electrocardiogram (ECG), and/or by ambulatory ECG in all the children and the mechanism of tachycardia was determined by previously published surface ECG and electrophysiologic criteria in all but one child. Of the eight children, three had atrial ectopic tachycardia, three had automatic junctional ectopic tachycardia, one had atrioventricular (AV) nodal reentry tachycardia and one had atrial reentry. All the children except one had failed trial of two or more antiarrhythmic drugs prior to moricizine therapy. The duration of moricizine therapy ranged from 4 days to 25 months. In three of the eight children (patients 3, 5 and 7), who presented with AV nodal reentrant tachycardia, automatic junctional ectopic tachycardia and atrial ectopic tachycardia, respectively, moricizine therapy was effective in restoring sinus rhythm and controlling the clinical tachycardia. Only one child (patient 1) developed proarrhythmia, an episode of fast, narrow-QRS supraventricular tachycardia lasting for 30 s, on the third day of therapy. This was subsequently confirmed by electrophysiologic study to be AV nodal reentrant tachycardia. The other side effects noted were non-cardiac, not dose-dependant and did not require dis-continuation of therapy. Based on our small series and those of others, moricizine, a newer class I anti-arrhythmic agent, has a limited but useful role in the management of recalcitrant type of supraventricular tachycardia, such as ectopic atrial and junctional tachycardia in children.
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Affiliation(s)
- A V Mehta
- Department of Pediatrics, James H. Quillen College of Medicine, East Tennessee State University, Johnson City 37614-0002, USA
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Wu MH, Lin JL, Chang YC. Catheter ablation of junctional ectopic tachycardia by guarded low dose radiofrequency energy application. Pacing Clin Electrophysiol 1996; 19:1655-8. [PMID: 9091848 DOI: 10.1111/j.1540-8159.1996.tb03196.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The prognosis of junctional ectopic tachycardia has been poor. A 9-year-old boy with dilated cardiomyopathy and this incessant form of tachycardia underwent RF ablation. Without retrograde atrial depolarization during tachycardia, serials of low dose RF energy were applied near the His-bundle area to find out the arrhythmogenic foci. The optimal site for ablation showed rate acceleration at low dose application and rate slowing down followed by conversion upon increasing the energy. By using this guarded low dose ablation technique, the tachycardia was eliminated without AV block. The LV function also improved.
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Affiliation(s)
- M H Wu
- Department of Pediatrics and Internal Medicine, National Taiwan University, Taiwan
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Abstract
In recent years, the distinction between the diagnostic and therapeutic techniques used in the assessment and management of pediatric and adult patients with arrhythmias has gradually blurred. Nonetheless, arrhythmias in the pediatric patient are still often different from the adult patient in one of two important ways. First, a variety of arrhythmia mechanisms remain relatively unique to the pediatric population, some because of developmental issues and others because of early presentation of an incessant tachycardia. Second, the presentation and management of certain arrhythmias is sometimes markedly affected by patient age or the presence of structural congenital heart disease. A sampling from each of the above categories is reviewed and discussed.
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Affiliation(s)
- J P Saul
- Department of Cardiology, Children's Hospital, Harvard Medical School, Boston, MA, USA
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Scheinman MM, Gonzalez RP, Cooper MW, Lesh MD, Lee RJ, Epstein LM. Clinical and electrophysiologic features and role of catheter ablation techniques in adult patients with automatic atrioventricular junctional tachycardia. Am J Cardiol 1994; 74:565-72. [PMID: 8074039 DOI: 10.1016/0002-9149(94)90745-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A total of 8 patients with junctional tachycardia (JT) were included for study. Patients with JT had a supraventricular arrhythmia that was initiated by a junctional complex without PR prolongation and episodes of atrioventricular (AV) dissociation. JT could not be initiated by pacing and occurred either spontaneously (3 patients) or with isoproterenol (5 patients). Tachycardia could be consistently terminated by either carotid sinus massage (1 patient), intravenous adenosine (2 patients), or critically timed ventricular premature complexes (3 patients). In 6 of the 8 other patients, tachycardia foci (atrial or ventricular) or mechanisms (AV node reentry) were found. Two patients underwent complete AV junctional ablation and 2 had termination of tachycardia without change in the AV conduction by perinodal application of radiofrequency lesions. AVJT appears to be due to abnormal automaticity and may be successfully ablated by application of radiofrequency energy to perinodal areas.
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Affiliation(s)
- M M Scheinman
- Department of Medicine, University of California, San Francisco 94143-1354
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